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Anger versus Abuse

4/30/2016

Contrary to what many of us thought growing up expressing anger is not the same as yelling, breaking things or slamming doors. In fact if the person you are interacting with is doing things that trigger your fight or flight system (make you sweat, shake, want to retreat, raise your blood pressure and/or heart beat, etc.) then you are not witnessing someone's anger, you are in the presence of abuse. Yep, that's right! And the normal human response to being abused is to want to hurt the other person back. So we yell, stomp our feet, throw things or say mean hurtful stuff back. Now WE are being abusive as well.

I think this is a very important distinction to make. Anger is actually NOT a damaging emotion. Abuse is damaging treatment. I repeat, anger and abuse are NOT the same. I can sit down calmly and tell you that I am angry because you borrowed my car and ran it out of gas. If you feel embarrassed, guilty, sad or contrite but NOT fearful, nervous, threatened or like you need to yell at me then I have NOT been abusive. I have just been angry. Anger is an indication that our boundaries have been violated. I don't like it when people do not show appropriate respect for my things and so if you use my car and don't put gas in it I am going to be angry. But that's OK. By conveying that I am upset it shows you that you have crossed a boundary and so you will try not to do that in the future.

Many of us who grew up in dysfunctional homes confuse anger and abuse. We think that if someone is red-faced, yelling, shaking mad, throwing things or hurling awful accusations at us they are "angry". I would argue it is much more useful to see this as abuse. That way both people can see how unhelpful and inappropriate this behavior is. Abuse never leads to anything good. Anger, when expressed without turning in to abuse, should ALWAYS lead to something good. It is a communication about what you need to feel respected, cared for and even loved. It is essential for you to communicate this so that you are taking care of yourself and protecting the bond you have with that person. It is important for them to hear this message clearly and take corrective action. That is the purpose of anger. The purpose of abuse is to discharge physical energy and to hurt the other person. That is not anger. The expression of anger is about trying to identify and solve a problem. Venting, which many people mistake for the expression of anger, is about hurting the other person in an effort to make yourself feel better without any regard for the other.

One of the most well-known authors on anger is Harriet Learner, who wrote The Dance of Anger. In an interview on the Relationship Alive podcast Ms. Learner suggested that the worst time to communicate your anger is when you are angry. She recommends calming down first and then discussing your anger. What? Yes! Talk about your anger when you are NOT angry. I know, mind-blowing. It makes me think of when a toddler has a temper tantrum and we tell them to go calm down. Then we ask them to use their words to talk about why they were upset. The same applies to us. When you are activated and angry you need to NOT talk but rather step away briefly and do some deep breathing or other things to get your nervous system regulated. Then you can engage the person who made you angry and explain what they did that was so offensive.

In thinking about positive expressions of anger that are clearly not abuse think about the sit-ins of the civil rights movement in the US. There was plenty of anger on the parts of the protestors who saw the racial oppression and abuses going on. However the play-book of those sit-ins was literally that "not a hair on the head of [the oppressors] would be disturbed". The protestors wanted to convey their anger appropriately and NOT allow it to turn into abuse, which would have spurred an abusive reaction on the part of the authorities. Abuse begets abuse. Anger, if expressed appropriately and without abuse, should beget positive results and heightened mutual understanding.

Anger can teach us things about ourselves and reveal things about our partners or other loved ones. If the anger seems out of proportion to the event (you bring my car back with no gas and I calmly tell you we can no longer be friends) then there is likely some "unfinished business" being triggered from the past. In this example perhaps I had parents who used my property, resources or accomplishments for their own selfish purposes and I felt used and mistreated. I am, therefore, naturally sensitive to feeling that others don't care how they treat me and are going to take advantage of me. So my anger in this situation, if I can see that it is out of proportion, will direct me to look at areas of my past where maybe I have some unresolved wounds. That in turn provides an opportunity for healing.

Understanding the purpose of anger can help us to not suppress or deny it. Understanding the difference between anger and abuse can help us learn to express anger in an appropriate way that can lead to increased knowledge, understanding and harmony for ourselves and in our relationships.

If you find yourself confused about or uncomfortable with anger I encourage you to think about tackling that problem. Anger turned inward/suppressed can lead to depression, loss of motivation, difficulties in achievement, addictions, poor self-care and even self-attack or self-abuse. Anger expressed as abuse can lead to shame, loss of relationships and/or jobs and even legal problems. Therapy can be an excellent tool for learning more about anger and how to comfortably express as well as witness it, as can the 12-step group Adult Children Anonymous (which focuses on people from any type of dysfunctional childhood) or books such as The Dance of Anger. Regular exercise and/or mindfulness mediation can help stabilize the nervous system so that when you feel angry you are better able to prevent it from veering into abuse. Proper sleep and not over-using stimulants like caffeine and energy drinks can also be helpful in keeping one's nervous system stable. Classes on anger management can help you learn the physiological signs of anger and how to manage the feeling when it arises and stay grounded when you see it in others. There are many options for working on this problem and I hope you consider trying some of them.

Wishing you health and happiness,

Dr. Jordan

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Everything You Need to Know or Were Afraid to Ask About Suicide

4/18/2016

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Perhaps no other death carries as much stigma and pain as suicide.

Family and friends wonder what they could have done, how did they miss the signs? They grieve the loss of not only the person but all that they could have become, the life spread out before them unfinished. Suicide has become a larger and larger problem in our country, claiming young and old, rich and poor, crossing boundaries of gender, color and religion.

And yet despite most of us knowing of a suicide in some way -- a classmate, a relative, a friend of a friend, we don't as a society talk about it openly most of the time. So here are some questions you may have wondered and some "straight talk" about suicide.

Please remember to take ALL suicidal gestures and comments seriously. If someone is talking about suicide call the Suicide Prevention Lifeline at 800 273 8255. You can also take the person to any hospital emergency room or if you are in Texas you can call 911 and ask for a Mental Health Deputy. These are police officers with additional training in mental health evaluation. They are mobile and can go to the person in crisis.

You can't "give" someone the idea to kill themselves by asking them if they are thinking about it. Most people who attempt suicide told someone within a week of the attempt that they were thinking about it. If you are concerned, ask. Be specific, such as "are you having thoughts of hurting yourself?"

The only way to "give" someone the idea to kill themselves is if you yourself commit suicide. In that sense suicides are catching, which is an important reason not to do it! You do not want to increase the risk that a loved one will follow suit.

Most people who are serious about killing themselves have a specific plan with a specific means in mind. Once they start down that road of executing their plan if something goes wrong it creates a temporary opportunity for them to be derailed. This is important to know because if someone has started to plan a particular means, like using a gun or using some pills that are in the medicine cabinet, you can remove the means and create an opportunity for intervention. The person won't just immediately try another means. The depressed brain is SLOW and needs time to think of another plan. So removing means when you have someone who is perhaps contemplating suicide does buy you time.

On the other hand, no one can control another person. If a person is hell-bent on killing themselves eventually they may succeed no matter what you do. While in training I was working in a psychiatric emergency room when a woman who had been admitted for suicidal risk. She was placed in an observation room and was getting 10 minute checks when she strangled herself successful with her hospital gown and died. If you fail to keep someone from killing themselves PLEASE do not feel responsible. No one can guarantee another person's safety, even in a highly controlled environment with professionals. But putting your loved one in such an environment is bound to reduce the chances of them being successful.

It's harder to die than you think. While working in that same facility in one summer I met a man who jumped 3 stories down in an effort to kill himself and only ended up breaking all of the bones in his pelvis, both legs and both feet. He would never walk normally again and would most likely have pain the rest of his life -- but he did not die. Another patient on the same ward has tried to shoot himself in the temple but the gun jerked as it fired and the bullet actually travelled around the skull and exited the other side of his face, blowing most of that side of his face off and severely damaging his eye. So he was partially blind and severely disfigured -- but very much alive. These are the kinds of things that people considering suicide need to hear about. They cannot guarantee that their attempt will work and believe me if they think their life is bad now it can be A LOT worse after a failed attempt. Telling a suicidal person these types of stories can sometimes cause them to reconsider. Always follow these conversations up with getting the person professional help. Just because they have reconsidered in the moment does not mean that they don't need to talk to a professional as soon as possible.

While this sounds distasteful,it's important to combat the romanticized image that a suicidal person has of death. Reminding them of things like how our bowels and bladders release when we die can actually give them pause. Have them think about who will find them and the trauma that person must endure forever with that image stuck in their mind. Make them think about how much worse things will be if they survive but are crippled, or are successful but go to hell (if they are religious). If they have children you can let them know that their kids will be at significantly higher risk of killing themselves due to their parent's suicide.

Women tend to use less lethal means such that although they try almost twice as often they succeed only half as much. Men try roughly half as often but succeed twice as often. So take a suicidal male VERY seriously.

Being male isn't the only factor that makes a person more dangerous. In terms of "lethality" the following characteristics really up your risk of attempting suicide: Having sustained a recent significant loss (job, spouse, relationship, money, etc.); being over 40; having access to violent means like a gun; having a substance use disorder; having a mental illness such as depression, anxiety, bipolar disorder, ADHD, schizophrenia, etc.; having a blood relative who attempted or completed suicide, ESPECIALLY a parent; having "reunion fantasies" in which you believe that once you die you will be reunited with a loved one who has passed on; hopelessness (not the same as sadness); social isolation; major physical illness; previous attempt yourself; and a history of trauma or abuse. A qualified mental health professional will take all of these risk factors into consideration in deciding the best course of action to help someone thinking about suicide.

Just because someone has attempted suicide multiple times and not succeeded DOES NOT mean that you should not take them seriously. There are some people who use suicidal threats and gestures (not well thought out and not very lethal attempts) as a means of communicating their distress. While after a while friends and family might feel that this person is "crying wolf" and stop taking it seriously this can really backfire. Often people who do not really want to die but want to solicit the acknowledgement and help of their loved ones will plan a way to make sure that they are rescued such as taking pills right before someone comes home or leaving the bathroom door open while they are cutting their wrist so that someone is bound to see them. Sometimes their plans go awry, however. Sylvia Plath, a very famous poet, stuck her head in the oven to die from gas inhalation but planned it so that a repair person (with whom she had scheduled an appointment at a certain time) would show up and find her. The repair person was late and so she died, despite not having intended to. ALWAYS take suicidal threats seriously.

You do not need to take a person to a mental health facility if they are suicidal. You can take them to ANY hospital emergency room. If there are no psychiatrists on staff one will be called in.

There is no age too young for suicide. I have seen 5 year old children attempt it. Take all talk about suicide seriously, even in young children.

Many non-prescription medications can be lethal in overdose so if someone has taken large amounts of ANY medication, prescription or not, they need to be evaluated by a doctor. What is a large amount? Anything over the recommended dose. You can always call the poison control hotline to ask questions about specific medications. Tylenol and acetaminophen in particular are very toxic in large doses. Do not just tell someone to "sleep it off" if they have attempted an overdose with even non-prescription medication. They need immediate medical attention.

DO NOT always induce vomiting when someone has ingested a toxin-- get advice from poison control. Some fluids such as bleach or other cleaning solvents burn esophageal tissue and can do more damage coming up. Contact a poison control hotline to find out whether or not to induce vomiting after ingestion of a poisonous substance.

Hopefully you will never need this information but it's better to be prepared to deal with this potential mental health crisis in case it happens. If you are feeling suicidal PLEASE contact a hotline, the police or a mental health provider immediately. Suicidal feelings can be treated but only if you ask for help.

Best wishes,

Dr. Jordan

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The Care and Feeding of Your Wave (Or...Loving Your Angry-Resistant Partner)

4/10/2016

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I recently published a blog on the "Care and Feeding of your Island/Avoidant Partner". Since one of the main principles of successful relationships is that they are fair and equal it only makes sense to talk about how to take great care of wave-ish partners. So here goes...

Wave-ish folks, like the rest of us, are subject to becoming more wave-ish once married. This has to do with breaching that final level of commitment to where our partners are now also family. We all carry around inside of us memories of how we were treated in childhood, and how we observed our family members treating each other. These templates are more flexible and less evident in our relationships with our friends and co-workers. Once someone enters into the realm of true family these templates are often re-activated in powerful ways and they tend to amplify our natural tendencies learned as children.

So as with Islands, once Waves are truly committed you may see the following tendencies emerge more strongly:

Fear abandonment, even in ways that seem more minor. Wave-ish folks experienced inconsistent parenting, such that they were sometimes coddled and given lots of attention but then sometimes unexpectedly rebuffed or pushed away and even shamed for being "too needy" or "too much". They intuitively expect the other shoe to drop and expect to be rejected. This gets worse with commitment for the reasons mentioned above. Your wave-ish partner may start reacting to you leaving, even if you are just running some errands, leaving you feeling bewildered and frustrated. Know that departures can be triggering for them and depart with an extra dose of love. Let them know that you are leaving but will be thinking of them while you are gone and look forward to seeing them when you get back. Give them a hug before you leave. Send them a text (doesn't have to be fancy, a heart or smiley face will do) while you are out. Think of them as a kid who gets nervous when their mom or dad are suddenly unavailable. They need reassurance around both departures and reunions.

Can get prickly when you reunite after being apart. Again this can be VERY confusing for their partners, who have no idea that the separation was stressful. They come home from running some errands to a wave-ish partner picking a fight. Crazy, I know. But remember that they fear you leaving and when you do they may feel a surge of anger at being left. Since they tend to have trouble letting go of the past they may think about this the whole time you are gone. Then when you get back, wham! they let you have it. THEY DON"T DO THIS CONSCIOUSLY OR ON PURPOSE. Please, please, keep this in mind. It is no picnic for them either. No one likes to feel upset, so if your wave-ish partner is being cranky or downright mad remember that what is underneath that is emotional pain. They are hurting. One of the most fool-proof ways to soothe a wave-ish person is to hold them. They usually melt under touch. They also tend to love eye-contact. So hold them, gaze lovingly into their eyes and tell them that they can depend on you to never leave them.

Can ramp up their emotional intensity, especially if you are island-ish. Remember the opposite styles amplify each other. So if you are island-ish, after marriage or deep commitment you will tend to move away a bit. This is likely to bring about protest behavior from your wave. It may be more clinging or it may be more frustration and accusations about how aloof you are. Or both. Try to remember that a wave-ish person is like a fussy baby. They make a lot of noise and you may be inclined to simply leave rather than deal with the fuss. But just like a crying baby they need your help, love and soothing. They tend to calm down MUCH faster than their partners think. So moving in, using touch, soothing words and eye contact can usually get a wave-ish person to get some emotional equilibrium pretty quickly. Even if you are not an island your wave-ish partner may get extra emotional after the deep commitment. Be prepared for this and don't blame them or tell them they are crazy. They are expressing their fear that you are not going to connect to them. Waves need a lot of connection and get more dramatic and emotionally messy when they don't get sufficient connection. Sadly they often unconsciously drive people away with their "fussiness", depriving themselves of the connection they need to get calm again. So know this and help them. It will pay you back tenfold in that you will not only have a more calm partner but you will have a partner who is eternally grateful to you for knowing what they need and giving it to them. Like islands, waves are often misunderstood. Your job is to not fall into that trap, to know them and take care of them.

May "spoil" things you try to do for them. This one is bound to make you feel crazy but remember they are not doing it intentionally. They want to be happy, just like any person does. However, since they have a childhood history of having the other shoe constantly dropped they anticipate being disappointed. So if you do something nice for them they may just turn around and "spoil" it somehow. If you take them out to dinner they may complain about the restaurant. If you buy them a gift they may tell you it's not their style, or the wrong color, or whatever. While the natural reaction to this would be to tell them to take a hike, you need to remember that they are acting from childhood pains. Tell them how much you love them and that you know they have been disappointed in the past. Tell them you don't want to disappoint them and you are open to hearing what they need from you. Don't take it personally when they try to spoil a gift or kindness. I know it's a tall order but you will be healing a deep and very painful wound from their childhood. Which is really, in my opinion, what marriage is all about. And that's a two-way street, so when you heal your wave's painful childhood issues they will do the same in return. Everybody wins, which is why marriage is so great!

Tend to respond with a negative a lot of the time. So if you propose a vacation to the beach they are likely to tell you the five reasons that's a bad idea. Don't bite. Just let them know that you know that they tend to find "what's wrong with the picture" before being willing to see what might be right. Tell them you are going to overlook their first response and give them another chance. If your partner is good with humor, you can say something like "OK my beautiful nattering naybob of negativity, now that you have gotten all the no's out of your system, can we revisit the idea?". Then flash them a loving smile. When used with love and kindness humor can be a great way to re-boot an activated wave.

May get really preoccupied with being "too much" or "too needy". Remember that wave-ish folks had childhoods where people alternately showered them with attention and told them they were too much and rebuffed them. So they are naturally afraid of overwhelming people. Paradoxically this leads to a lot of anxiety, which can make them more emotional, more clingy and more negative. Which has the unintended consequence of making their parter get exasperated with them! Be on the lookout for your wave-ish partner feeling judged as too needy or rejected. A wave-ish partner may misinterpret signals like you looking away during a conversation or sighing when they tell you something they need. Be careful to let your wave-ish person know they are NOT too much for you and that you have no intention of leaving them. Help them feel safe and secure and you will find their wave-ishness will actually diminish!

May have trouble ending an argument or letting it go afterwards. Wave-ish folks have trouble with endings, even arguments! They may keep it going because closing up something feels in a way like loss. They may also hold on to hurts from the past to act as a bulk-wart against being vulnerable towards you in the future, which they fear will be rewarded with more hurt! Help your wave let go in an argument by reminding them that while there may be a part of them that tends to hang on their body and mind deserve relief. Hold them tight at the end of a rough conversation and reassure them that if they let go they are not going to be setting themselves up for additional injury.

May not look out well for their partner in social situations. If you go to a party or event your wave-ish partner may wander off and socialize and "drop" you. This is because their parents dropped them (emotionally) as kids. Don't take this personally and remind them before you go out to social events that you would like for them to keep track of you and circle back at predetermined intervals to keep you feeling connected.

Waves are not any more difficult than islands. And like islands they do not do these things "on purpose" or with the intent of making their partner crazy. Learn to love your wave and help them to manage their emotional reactivity. They will greatly appreciate your help in containing some of their intensity and you will feel calmer knowing you are not about to be plowed under by a tsnumami!

Wishing you happiness and health,

Dr. Jordan

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The Adverse Childhood Events Study

4/4/2016

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For the last several decades physicians and mental health workers have theorized that there is a link between difficult childhoods and physical health.

Many clinicians noticed that the patients who reported abuse or serious neglect in childhood seemed to have very poor health.

The ACEs study actually found a link between traumatic events in childhood and the following illnesses:

That link has finally been fleshed out in a very (more than 17,000 participant) study called the Adverse Childhood Events Study (ACEs). According to the Adverse Childhood Events Study (http://attachmentdisorderhealing.com/the-greatest-study-never-told/) 66% of people surveyed had one or more types of childhood trauma and 38-42% had two or more. And this is in a study of middle-class people living in San Diego, California. Certainly children in more impoverished or desperate settings fare far worse.

For those who had childhood events that were traumatic, they suffered more ischemic heart disease, cancer, chronic lung disease, skeletal fractures, liver disease, autoimmune diseases, depression, suicidality, chronic anxiety, amnesia, and hallucinations. Some of these links are intuitive. For example if you suffered physical abuse in childhood it's not a stretch that you may have broken bones as a result. Also if you were emotionally abused you may end up trying to cope by using alcohol or drugs, causing liver damage. But things like heart disease or cancer seem more elusive. Is the link the immune system? the inflammatory response? Scientists are still working out the direct linkage but the fact that early childhood traumatic events stay with us now has scientific support.

So what can be done about this? We cannot go back and change our childhoods. However, we can recognize that childhood trauma can create responses in the body, such as heightened fight-or-flight responses, that warrant accommodation. If one has had significant abuse in childhood, for example, one may want to take extra care to incorporate relaxation strategies to encourage the body's relaxation response. These strategies include techniques such as diaphragmatic breathing, guided imagery, self-hypnosis, progressive muscle relaxation and meditation. By doing some of these on a daily basis one can counter-act the body's heightened fight-or-flight response that can contribute to stress related illnesses such as hypertension, diabetes, insomnia, obesity, skin conditions, headaches, stomach problems, irritable bowel syndrome, depression and anxiety. Even 10 minutes each day can help re-wire the brain to maintain a more relaxed stance throughout the day.

Psychotherapy can help as well. By reviewing one's history (which, incidentally is NOT the same as re-living it!) and coming to terms with it people can reduce some of the physiological reactivity that had previously been attached to those memories. Techniques like EMDR, Somatic Experiencing or Sensory Motor Psychotherapy can be especially helpful in re-setting the bodies response in order to avoid the constant fight or flight response.

If you have had adverse childhood events in your life, even if you do not feel that you are being negatively effected on an emotional level, it may be advisable to discuss your history with your physician. As medicine and psychology become more integrated we can all benefit from the intersection between these two disciplines.

Yours in health,

Dr. Jordan

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Reflections on all things psychological and the science of being human

Anger versus Abuse

Everything You Need to Know or Were Afraid to Ask About Suicide

The Care and Feeding of Your Wave (Or...Loving Your Angry-Resistant Partner)

The Adverse Childhood Events Study

Krista Jordan, Ph.D.

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